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Bone Cancer Development of Bone Cancer • Advancing age and a previous history of cancer are the two most important risk factors for cancer • Primary bone cancer is uncommon; however, the skeleton is the most common organ affected by metastatic cancer. • Primary cancers of the breast, prostate, thyroid, lung, and kidney commonly metastasize to the bone. • Cancer is more likely to metastasize to the vertebrae, pelvis, ribs, skull, proximal femur, sternum, or cervical spine. • Bone pain in the lumbar spine or proximal femur can refer pain to the knee. Common Risk Factors • Age over 50 years • Ethnicity: racial minorities and ethnic groups are at an elevated risk • Family history • Environment and lifestyle Presentation of Bone Cancer • • • • • • • • • • • • Deep pain Poorly localized Pain increases with activity Pain description: burning, aching, stabbing Pain is cyclic and progressive until it becomes constant Decreased tolerance to weight bearing Antalgic patterns. Bone pain does not respond well to physical agents Soft tissue swelling Pathologic fractures Hypercalcemia Back or rib pain Additional Signs and Symptoms • Unexplained changes in appetite • Unexplained weight gain or loss of 10% of total body weight within the last 4 weeks • Proximal muscle weakness – if the nerves are compressed • Change in two or more deep tendon reflexes • Palpable lump or mass • Pain present at night, unrelieved by change in position Tests to Differentiate • Heel strike test – Pain reproduced is indicative of a fracture – Fractures can also be associated with tumors • Pain that subsides with salicylates is characteristic of an osteoid osteoma – Osteoid osteoma is a benign osteoblastic tumor that commonly occurs in the diaphysis of long bones • Occurs usually between ages 7 to 25 Recommendation • Refer to primary care physician for further testing Reference • Siegenthaler, Walter. 2007. Siegenthaler’s Differential Diagnosis in Internal Medicine: From Symptom to Diagnosis. Georg Thieme Verlag. Stuttgart, Germany. 1144 pages.